To my fellow physicians and patient providers, how many of your patients have gained weight and blamed it on the pandemic due to limited options for physical activity outside of the home?
Unsurprisingly, almost all of my patients I’ve seen over the past year have fallen victim to this, with good reason. They are protecting their health by avoiding exposure to COVID-19 but at the same time are unconsciously neglecting their health by not having the means or green light to engage in healthy behaviors such as going to the gym, walking in public spaces, and engaging in aerobic exercise and strength training. Our current restrictive environment combined with more time at home to eat and indulge is a fail-proof setup for adding on these harmful extra pounds.
So what can our patients control and how do we motivate them? This reminds me of my roommate in medical school who once told me that I “live to eat” because I would act immediately on a food craving and would also plan my next meal while actively eating a meal in front of me. I asked him if he also followed this same dogma of being an “emotional eater” and acted impulsively on energy-dense, nutritionally lacking foods. He responded with “I eat to live” because he only thinks about food when his body sends him the appropriate signals. I had to think about this. Yes, “stress-eating” is a habit that many of us are using as a coping mechanism during the COVID-19 pandemic.
Food culture is central in many cultures across the world. Food brings people together, establishes common ground amongst strangers, and provides satisfaction and emotional fulfillment while traveling, learning, and growing. We’re social creatures who naturally select to build connections that many times are centered around meals. But when the balance tips towards overindulgence and away from physical activity and healthy mindfulness is when chronic diseases such as coronary artery disease and its associated comorbidities arise.
For many of us, we understand what we should eat to become healthier, however, that does not mean we will actually follow this rationale to maintain a heart-healthy diet, especially during a pandemic when most of our day is spent sedentary in isolation at home. Despite having a master’s degree in Nutrition as part of my training, I can admit that I have invariably fell victim to the vices of food comfort at home. I was eating a lot of baked desserts after dinner but recently decided to replace this habit with a cup of hot chocolate made with soy milk and sugarless cocoa powder.
So how do we combat this? We know the right food prescriptions of diet to provide our patients and have all heard the saying of “you are what you eat.”
Let me quickly review the 4 strategies of motivational interviewing (OARS) and a few quick tips to help our patients (and ourselves) make gradual and achievable nutritional changes:
- Open-ended questions- this allows your patient to explore and think more deeply about personal goals.
- Affirmations- highlight your patient’s strengths and skills to support self-efficacy
- Reflections– reflective listening and providing empathy deepens the trust with your patient; avoid making judgments as patients become may become defensive
- Summaries- summarizing the above then allows you to move on to making a specific plan with your patient
Here are 5 tips to help your patients make healthier food choices during the pandemic:
- Allow your patient to decide on 1-2 specific food goals per week (this can involve eliminating one food item they are able to identify that is unhealthy or decreasing the amount of this food item per day or week).
- Empathize with the difficulty of being at home and that boredom by itself can cause overeating. Prior to eating, challenge them to take a few seconds to determine whether or not they are hungry or are deciding to eat because they are bored.
- Make a goal of drinking at least 8 glasses of water a day- being underhydrated can in turn cause overeating of salt-laden foods.
- “Eat your calories, don’t drink them.” Ensure that your patient is avoiding caloric beverages. If they enjoy fruit juices, ask that they try eating fruits as the fiber benefits are much more plentiful with less additive sugars.
- Lastly, congratulate them on their decision to make a change and have a specific follow up plan to continue building on the changes they are making.
Kyla Lara-Breitinger, MD, MS
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